healthcare system. in 2008, americans made almost one billion office visits to the dr.. 50% were to primary care doctors. according to patrol -- access to primary health care results in better health outcome, reducing health disparities, and lower spending by reducing emergency room but when you get people to the dr. when they showed, they do not get sicker than they otherwise would be at great cost. the problem we are discussing is a national problem existing in 50 states and the country. it is even worse for particular geographic regions. the ratio of primary care doctors in urban areas is 100 per 100,000 people. double the ratio in rural communities where it is 46 per 100,000. urban communities have problems. rural communities have greater problems. 65% of primary health care a national shortage areas are in rural counties. my own state does better than the rest of the country in terms of primary health care providers per 100,000. i cannot tell you -- and vermont, people have difficulty getting to th